Kimmo Pahkala

Prevalence of depression in an aged population in Finland

The prevalence of depression by sex, age and certain sociodemographic variables was investigated among elderly Finns (65 years or over) living in the semi-industrialized town of Ähtäri (n=1225). The prevalence of depression, determined using the DSM-III criteria, was 16.5% for the total population, 14.4% for the men and 17.9% for the women. Dysthymic disorder was the commonest category of depression in both sexes, with atypical depression the second most common category among the men and major depression among the women. A few cases of cyclothymic disorder were diagnosed in each sex, but no cases of bipolar depression. The occurrence of depression was not associated with sex, but it was related to older age, widowhood and lower educational level in the men, although not in the women. In both sexes, a high risk of depression was associated with being in long-term institutional care and receiving home nursing and/or a home help. The occurrence of depression was not related to earlier occupation.

Social and Psychosocial Factors Predicting Depression in Old Age: A Longitudinal Study

The predictive value of social and psychosocial factors for the occurrence of depression in elderly Finns is described using a longitudinal design. A population determined as not being depressed in an epidemiological study in 1984-1985 was clinically interviewed and examined in a follow-up study in 1989-1990 (N = 679). The potential predictive factors for depression were analyzed by contrasting the persons depressed in 1989-1990 with the ones not depressed. In men, depression was predicted by a poor relationship with ones wife and feelings about low appreciation of old persons or of the participant himself during the initial study and the loss of a mother while under 20 years of age. Certain changes and life events during the follow-up were related to the occurrence of depression in men, such as a change in the relationship with ones wife into a poorer direction, a decrease in the amount of hobbies, getting married, a grandchilds divorce, separation from someone important, moving into long-term institutional care, giving up hobbies or a position in a voluntary organization, and alcohol problems of a close person. In women, depression was predicted by living together with ones husband, living with other people, and a low activity in participating in religious events during the initial study and a loss of father while under 20 years of age. The risk of women living alone was lower compared to women not living alone. Also, certain changes and life events during the follow-up were associated with a high risk of depression in women, including a change in the relationship with ones neighbors into a poorer direction, an increase in the amount of time spent alone, a decline of the social activity level, getting married, occurrence of serious marital problems, separation from someone important, giving up hobbies or a position in a voluntary organization, alcohol problems of a close person, and a small number of social growth events. The results support the hypothesis about psychosocial factors playing a role in the etiology of depression in old age.

Follow up study of longstanding depression as predictor of mortality in elderly people living in the community

Longstanding and recurrent depressive disorders are quite common in elderly people. 1 2 Not much is known, however, of their clinical course and prognosis, including mortality. The need for treatment of longstanding, less severe depressive disorders is a matter of discussion. We studied the relation between longstanding or recurrent depressive disorders and mortality and that between recovery from depressive disorders and mortality in elderly people. This study is based on the Ahtari longitudinal epidemiological research project concerning depression in elderly people.1–3 The initial series consisted of people born in 1923or earlier and living in the municipality of Ahtari, Finland, on 1January 1984(n=1529). In the first study in 1984-5the participation rate was 91%. The follow up study was performed in 1989-90with a participation rate of 94%. Depression was determined after semistructured interviews by the criteria of the Diagnostic and Statistical Manual of Mental Disorders , third edition (DSM-III).1–3 View this table: Predictors of mortality …

Clinician-Rated Symptoms and Signs of Depression in Aged Finns

The study describes symptoms and signs of depression in elderly (60 years or over) Finns. Lists of symptoms and signs assessed by the examining physicians in a popula tion study were used in rating, and the symptoms and signs of persons diagnosed as depressed were compared to those of persons who were not depressed. The commonest symptoms both in men and women were sleep disturbances, fatiguability, loss of interest, depressed mood, loss of activity, pains, pessimism and sense of uselessness. In addition, worry was a common symptom in women. Hallucina tions and other delusions than those about unforgivable behaviour were very uncom mon. Loss of libido did not strongly indicate occurrence of depression, and in persons aged 70 years or over it could not be included in symptoms of depression. Sex dif ferences in the commonest symptoms of depression were evident: worry, crying spells, helplessness, loneliness, suicidal ideas and pains were more common in depressed women than in depressed men. Some age differences in symptoms were also found both in men and in women. Sad expression was a common sign of depression in both sexes. In addition, slow movements, scarcity of gestures and slow speech were quite common signs in depressed men and stooping posture was quite common in depressed women.

The Prognosis of Depression in Old Age

A prospective follow-up of depressed elderly patients is described. The subjects, 91 men and 173 women aged 60 years or over, were diagnosed as depressed in an epidemiological study using the DSM-III criteria. One hundred ninety-nine patients suffered from dysthymic disorder. The mean duration of the follow-up was 14.9 +/- 4.3 months. Outcome was not associated with sex and was good in 41% of the cases. In men, poor outcome was associated with low social participation, low frequency of visiting contacts, and poor insight into the depressive disorder. In women, poor outcome was associated with multiple depressive symptoms, depression diagnosed previous to this study, not living alone, low social participation, low self-perceived health, diurnal variation of symptoms, and the occurrence of initial insomnia, loss of libido, and hypochondriacal and compulsive symptoms. Many similarities were found in factors associated with outcome between all depressed patients and the patients whose depression was diagnosed during our epidemiological study.

Six-year survival of depressed elderly Finns : A community study

Background. The 6‐year survival of depressed elderly (N = 290) Finns was assessed and compared to that of a non‐depressed population (N = 982), and the factors related to high mortality were analysed.

Dysthymic disorder in the aged in the community

SummaryThe prevalence of dysthymic disorder and and its relationship to social and health variables were investigated in a Finnish population aged 60 years or over. The prevalence was lower in men (17.2 per 100) than in women (22.9 per 100). In the total population the occurrence was higher in the widowed (24.9 per 100) than in the married (18.3 per 100). In men, dysthymic disorder was more common in those with a lower educational level (22.6 per 100) than with a higher educational level (15.1 per 100), and more common in persons receiving long-term institutional care or home nursing or home help (28.7 per 100) than in persons living independently at home (14.6 per 100). The rate was not related to age, marital status or occupation. In women, the occurrence was not related to age, marital status, education, occupation or form of social and health care. The female rate was higher than the male in the older group (70 yrs. +), in married persons, in those with a higher educational level and in those living independently at home. Underdiagnosing was evident. The occurrence of dysthymic disorder was related to poor health and poor functional status and to the occurrence of social and health stressors. No differences were found in the occurrence of the related factors between persons with dysthymic disorder and persons with major depression. Our results support the conclusion that the majority of cases of dysthymic disorders in the elderly are affective illnesses and not personality disorders.

Factors predicting chronicity of depression in elderly primary care patients.

AIM The aim was to identify the factors predicting and related to chronicity of depression among depressed Finnish elderly subjects. MATERIAL AND METHODS The study consisted of 97 depressed (DSM-III criteria) elderly (60 years or older) Finns treated in primary health care. The occurrence of depression was assessed after treatment and follow-up periods of about 15 months and 5 years, and the persons were classified according to their recovery: (a) persons depressed in all the three examinations (the chronically depressed) (n = 47), and (b) persons depressed in the first examination, but nondepressed in both follow-up examinations (the recovered) (n = 50). RESULTS Diurnal variation of symptoms and poor self-appreciation at the baseline and the onset of a severe disease, the deterioration of ones health status, and the death of a family member during the follow-up emerged as independent predictors or associates of the chronic course of depression in the logistic regression model. CONCLUSIONS Depressed elderly subjects who develop a physical disease or whose family member dies during the treatment of depression have a high risk for a chronic course. Intensive antidepressant and psychotherapeutic treatment and adequate physical treatment of these patients are proposed, in order to increase the probability of recovery from depression.

Five-Year Prognosis for Depression in Old Age

The 5-year prognosis for 264 depressed elderly Finns (60 years or older) living in the community and treated through the primary health care service is described. The majority of the patients were suffering from dysthymic disorder. It was found that 25% of the men and 35% of the women had recovered, 29% of the men and 24% of the women were still suffering from depression after the five-year period, 9% of the men and 11% of the women had become demented, 33% of the men and 26% of the women had died, and 4% of the cases were not contacted. The prognosis did not differ between the sexes, neither was it associated with age. Poor psychic health and pronounced depressive symptoms at the beginning of the treatment, and the occurrence of a serious disease or a decline in functional capacities during the follow-up were related to a poor prognosis in both sexes. The specific disease group related to a poor prognosis in women was that of cardiovascular diseases. A close connection between a poor prognosis and a low socioeconomic status was found in the depressed men, while a favorable prognosis was shown for relatively healthy, even widowed, depressed women who moved to live alone during the follow-up period, women who increased their amount of physical exercise, and men and women whose hobby activities increased.

Sex and age differences of factor pattern and reliability of the Zung Self-rating Depression Scale in a Finnish elderly population.

Sex and age differences on the Zung Self-rating Depression Scale and the reliability of the scale among an elderly population of 1358 were investigated. A principal-components factor analysis was performed, and the remaining factors were rotated using the orthogonal varimax rotation algorithm. Four factors emerged for young-old (60–74 yr.) men, three for old-old (75+ yr.) men, three for young-old (60–74 yr.) women, and four for old-old (75+ yr.) women. The first factor was similar for young-old men, old-old men, and young-old women, and dealt with “loss of self-esteem”. The first factor for old-old women dealt with “agitated mood with somatic symptoms”. The second factor was also similar for young-old men, old-old men, and young-old women, and it described “agitated mood with somatic symptoms”, being similar to the first factor for old-old women. The second factor for old-old women was similar to that of the first factor (“loss of self-esteem”) for the other three groups. The third factor for young-old men and old-old women described psychomotor retardation. For young-old women the theme of the third factor was “depressed mood”, and for old-old men the predominant theme was “somatic symptoms”. Somatic symptoms were the main theme of the fourth factor for young-old men and old-old women. These results showed that there are sex and age differences in the factor structure of the scale among the elderly population. Cronbach alpha coefficients were relatively high: 0.73 for young-old men, 0.75 for old-old men, 0.72 for young-old women and 0.77 for old-old women.